The relationship between arterial wall stiffness and left ventricular dysfunction

Objectives

The purpose of this study was to explore the relationship between left ventricular (LV) dysfunction and arterial wall stiffening.

Methods

A total of 218 patients over the age of 45 diagnosed with hypertension in Jinan City and hospitalised between 2010 and 2011 were included in this study. LV function was evaluated using echocardiography (ECHO). Blood pressure was monitored with an automated tonometric device, and the parameters of arterial wall stiffness were measured. In addition, the metabolic parameters of blood samples, such as glucose and lipids, were also determined using the Cobas E601 analyser.

Results

Stiffness parameter beta positively correlated with LV diastolic function (E/Em ratio) (r?=?0.255, p?<?0.001). LV end-diastolic diameter not only related to the E/Em ratio (r?=?0.196, p?=?0.009) but also with beta (r?=?0.220, p?=?0.002). The stiffness parameter beta was an early indicator of E/Em ratio as determined by multiple regression analysis (R ²?=?0.381, p?<?0.01). Age, blood pressure and fasting blood glucose contributed to stiffness parameter beta (p?<?0.05), as well as the E/Em ratio (p?<?0.01).

Conclusions

Our findings suggested that LV dysfunction may have a direct relationship to arterial stiffening, independently of having similar risk factors. In addition, arterial stiffness can be an independent predictor of LV diastolic function, suggesting that the severity of arterial stiffness directly correlates with the severity of LV dysfunction.     

Relation of arterial stiffness to left ventricular structure and function in healthy women

Background

Interactions between the left ventricular (LV) and the arterial system, (ventricular-arterial coupling) are key determinants of cardiovascular function. However, most of studies covered multiple cardiovascular risk factors, which also contributed to the morphological and functional changes of LV. The aim of this study was to examine the relationship between arterial stiffness and LV structure and function in healthy women with a low burden of risk factors.

Methods

Healthy women from the Twins UK cohort (n?=?147, mean age was 54.07?±?11.90 years) were studied. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cf-PWV). LV structure and function were assessed by two-dimensional speckle tracking echocardiography.

Results

cf-PWV was significantly associated with most measures of LV geometry and function, including relative wall thickness (RWT), E/e’ ratio, global circumferential and radial strain, apical rotation and LV twist (each p?<? 0.05), but bore no relation to global longitudinal strain. After adjustment for age, body mass index, blood pressure and heart rate, cf-PWV was significantly correlated with RWT, global circumferential strain, apical rotation and LV twist (β?=?0.011, ??0.484, 1.167 and 1.089, respectively, each p?≤? 0.05).

Conclusions

In healthy women with a low burden of risk factors, elevated arterial stiffness was intimately interwoven with increased LV twisting even before LV dysfunction becomes clinically evident.

     

The plasma concentration of advanced oxidation protein products and arterial stiffness in apparently healthy adults

BACKGROUND: Oxidative stress plays an important role in the pathogenesis of atherosclerosis. Advanced oxidation protein products (AOPP) are markers of oxidative stress and mediators of inflammation. Increased arterial stiffness is associated with increased risk of cardiovascular mortality and morbidity. The aim of this study was to evaluate the relationship between an indirect marker of arterial stiffness and the AOPP level in apparently healthy individuals. METHODS AND RESULTS: Arterial stiffness was estimated with the use of the stiffness index (SI(DVP)) which significantly correlated with age, mean blood pressure, body fat content and AOPP. The SI(DVP) was associated with AOPP concentration in both single (R = 0.22, p = 0.03) and multiple regression models adjusted for age, sex, mean blood pressure and body fat content (R(2) = 42%, p < 0.0001). CONCLUSIONS: The AOPP concentration is elevated in healthy people with increased values of stiffness index. This finding supports the concept that oxidative stress may contribute to arterial stiffening in humans.     

Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension

The aim of this study was to investigate the contribution of direct right-to-left ventricular interaction to left ventricular filling and stroke volume in 46 patients with pulmonary arterial hypertension (PAH) and 18 control subjects. Stroke volume, right and left ventricular volumes, left ventricular filling rate, and interventricular septum curvature were measured by magnetic resonance imaging and left atrial filling by transesophageal echocardiography. Stroke volume, left ventricular end-diastolic volume, and left ventricular peak filling rate were decreased in PAH patients compared with control subjects: 28 +/- 13 vs. 41 +/- 10 ml/m(2) (P < 0.001), 46 +/- 14 vs. 61 +/- 14 ml/m(2) (P < 0.001), and 216 +/- 90 vs. 541 +/- 248 ml/s (P < 0.001), respectively. Among PAH patients, stroke volume did not correlate to right ventricular end-diastolic volume or mean pulmonary arterial pressure but did correlate to left ventricular end-diastolic volume (r = 0.62, P < 0.001). Leftward interventricular septum curvature was correlated to left ventricular filling rate (r = 0.64, P < 0.001) and left ventricular end-diastolic volume (r = 0.65, P < 0.001). In contrast, left atrial filling was normal and not correlated to left ventricular end-diastolic volume. In PAH patients, ventricular interaction mediated by the interventricular septum impairs left ventricular filling, contributing to decreased stroke volume.     

Estimation of left ventricular operating stiffness from Doppler early filling deceleration time in humans

Shortened early transmitral deceleration times (E(DT)) have been qualitatively associated with increased filling pressure and reduced survival in patients with cardiac disease and increased left ventricular operating stiffness (K(LV)). An equation relating K(LV) quantitatively to E(DT) has previously been described in a canine model but not in humans. During several varying hemodynamic conditions, we studied 18 patients undergoing open-heart surgery. Transesophageal echocardiographic two-dimensional volumes and Doppler flows were combined with high-fidelity left atrial (LA) and left ventricular (LV) pressures to determine K(LV). From digitized Doppler recordings, E(DT) was measured and compared against changes in LV and LA diastolic volumes and pressures. E(DT) (180 +/- 39 ms) was inversely associated with LV end-diastolic pressures (r = -0.56, P = 0.004) and net atrioventricular stiffness (r = -0.55, P = 0.006) but had its strongest association with K(LV) (r = -0.81, P < 0.001). K(LV) was predicted assuming a nonrestrictive orifice (K(nonrest)) from E(DT) as K(nonrest) = (0.07/E(DT))(2) with K(LV) = 1.01 K(nonrest) - 0.02; r = 0.86, P < 0.001, DeltaK (K(nonrest) - K(LV)) = 0.02 +/- 0.06 mm Hg/ml. In adults with cardiac disease, E(DT) provides an accurate estimate of LV operating stiffness and supports its application as a practical noninvasive index in the evaluation of diastolic function.     

Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure

It is often challenging to assess cardiac filling pressure clinically. An improved system for detecting or ruling out elevated cardiac filling pressure may help reduce hospitalizations for heart failure. The blood pressure response to the Valsalva maneuver reflects left heart filling pressure, but its underuse clinically may be due in part to lack of continuous blood pressure recording along with lack of standardization of expiratory effort. In this study, we tested whether Valsalva-induced changes in the pulse amplitude of finger photoplethysmography (PPG), a technology already widely available in medical settings, correlate with invasively measured left ventricular end-diastolic pressure (LVEDP). We tested 33 subjects before clinically scheduled cardiac catheterizations. A finger photoplethysmography waveform was recorded during a Valsalva effort of 20 mmHg expiratory pressure sustained for 10 s, an effort most patients can achieve. Pulse amplitude ratio (PAR) was calculated as the PPG waveform amplitude just before release of expiratory effort divided by the waveform amplitude at baseline. PAR was well correlated with LVEDP (r = 0.68; P < 0.0001). For identifying LVEDP > 15 mmHG, PAR > 0.4 was 85% sensitive [95% confidence interval (95CI): 54-97%] and 80% specific (95CI: 56-93%). In conclusion, finger PPG, a technology already ubiquitous in medical centers, may be useful for assessing clinically meaningful categories of left heart filling pressure, using simple analysis of the waveform after a Valsalva maneuver effort that most patients can achieve.     

Relationship between sleep duration and arterial stiffness in a multi-ethnic population: The HELIUS study

We examined the relationship between sleep duration and arterial stiffness among a multi-ethnic cohort, and whether the associations differed among ethnic minority groups in the Netherlands. Data were derived from 10 994 participants (aged 18–71 years) of the Healthy Life in an Urban Setting (HELIUS) study. Self-reported sleep duration was categorized into: short (<7 h/night), healthy (7–8 h/night) and long (≥9 h/night). Arterial stiffness was assessed by duplicate pulse-wave velocity (PWV in m/s) measurements using the Arteriograph system. The association of sleep duration with PWV was analysed using linear regression (β) with 95% confidence interval (CI). Results showed that neither short nor long sleep was related to PWV in all ethnic groups, except for long sleep in Dutch men which was associated with higher PWV (indicating stiffer arteries) after adjustment for potential confounders (β = 0.67, 95%CI, 0.23–1.11). Our study showed no convincing evidence that sleep duration was related to arterial stiffness among various ethnic groups. The link between sleep duration and cardiovascular outcomes does not seem to operate through arterial stiffness. Further research is needed to consolidate these findings.     

The relationship between urotensin II plasma immunoreactivity and left ventricular filling pressures in coronary artery disease

The role of urotensin II (U-II)--a vasoactive, mitogenic, and inotropic, peptide--in the pathophysiology of heart failure is controversial. The present study explores the relationship between plasma U-II immunoreactivity (U-IIIR) and hemodynamics in patients with coronary artery disease (CAD). Thirty-six patients with CAD-3 undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and 36 medical patients (MED group) with CAD-1 to CAD-3 during right heart catheterization were studied. Significant correlations were observed between pulmonary capillary wedge pressure (PCWP) and U-IIIR--determined by enzyme immunoassay (EIA)--before (rho = 0.83) and after (rho = 0.6) cardiopulmonary bypass in the CABG group. With the exception of the CPB period, CABG patients with increased PCWP before CPB had higher U-II(IR) concentrations throughout the procedure. Significant correlations were observed between U-IIIR, proANP, proBNP, and mean right ventricular pressure (RVPM) in MED patients. No correlation was detectable between U-IIIR and PCWP. However, MED patients with CAD-3 (n = 13) had higher levels of U-IIIR, NTproANPIR (RIA), NTproBNPIR (EIA) and higher cardiac filling pressures than patients with CAD-1 (n = 13). These findings support an association between plasma U-IIIR levels and diastolic myocardial dysfunction in ischemic heart failure. The discrepancies regarding left and right cardiac filling pressures and U-IIIR levels in CABG and MED patients require further evaluation.     

Role of impaired myocardial relaxation in the production of elevated left ventricular filling pressure

Although present in many patients with heart failure and a normal ejection fraction, the role of isolated impairments in active myocardial relaxation in the genesis of elevated filling pressures is not well characterized. Because of difficulties in determining the effect of prolonged myocardial relaxation in vivo, we used a cardiovascular simulated computer model. The effect of myocardial relaxation, as assessed by tau (exponential time constant of relaxation), on pulmonary vein pressure (PVP) and left ventricular end-diastolic pressure (LVEDP) was investigated over a wide range of tau values (20-100 ms) and heart rate (60-140 beats/min) while keeping end-diastolic volume constant. Cardiac output was recorded over a wide range of tau and heart rate while keeping PVP constant. The effect of systolic intervals was investigated by changing time to end systole at the same heart rate. At a heart rate of 60 beats/min, increases in tau from a baseline to extreme value of 100 ms cause only a minor increase in PVP of 3 mmHg. In contrast, at 120 beats/min, the same increase in tau increases PVP by 23 mmHg. An increase in filling pressures at high heart rates was attributable to incomplete relaxation. The PVP-LVEDP gradient was not constant and increased with increasing tau and heart rate. Prolonged systolic intervals augmented the effects of tau on PVP. Impaired myocardial relaxation is an important determinant of PVP and cardiac output only during rapid heart rate and especially when combined with prolonged systolic intervals. These findings clarify the role of myocardial relaxation in the pathogenesis of elevated filling pressures characteristic of heart failure.     

Lack of association between Y-chromosomal haplogroups and prostate cancer in the Korean population

The Y chromosome has recently been suggested to have an association with prostate cancer risk in human populations. Since this chromosome is haploid and lacks recombination over most of its length, haplotypes constructed from binary markers throughout the chromosome can be used for association studies. To assess the possible Y-chromosomal contribution to prostate cancer risk, we have therefore analyzed 14 Y-chromosomal binary markers in 106 prostate cancer cases and 110 controls from the Korean population. In contrast to previous findings in the Japanese population, no statistically significant difference in the distribution of Y-chromosomal haplogroup frequencies was observed between the case and control groups of Koreans. Thus, our data imply that the previously reported associations between Y-chromosomal lineages and a predisposition to, or protection against, prostate cancer might be explained by statistical fluctuations, or by genetic effects that are seen only in some environments.     

Relationship between apexcardiogram,left ventricular pressure and wall stress

Simultaneous measurement of left ventricular dimension and wall thickness by M-mode echocardiography, of left ventricular pressure by a tip-transducer manometer, and of the calibrated apexcardiogram with a pixie beam transducer, were made during acute experiments on anaesthetized dogs. Instantaneo us values for chamber dimensions and wall thickness were obtained throughout the heart cycle by digitizing the echo-mechanocardigrams.From these data myocardial stresses, derived from a thick shell theory (meridional and circumferential components) and from Laplace's law, were computed. Laplace stress is shown to be an adequate expression for average wall stress. Its value was correlated with the calibrated apexcardiogram. The present investigation suggests that to a certain extent, the apexcardiogram not only reflects pressure changes but also dimensional changes of the left ventricle.     

Interrelationships between left ventricular volume and output during exercise in healthy subjects.

To better characterize the relationship between left ventricular volume response and improved ventricular ejection and output during supine exercise in normal subjects, 36 healthy asymptomatic volunteers (age 39 +/- 17 yr) were studied with radionuclide ventriculography during recumbent bicycle ergometry. Relative changes in left ventricular end-diastolic and end-systolic volume were measured at rest and during exercise by a modification of the radionuclide counts-based method that accounted for variability in stress blood pool counts. A biphasic response was noted in left ventricular end-diastolic volume with an initial increase in early exercise (8.5 +/- 11% at 200 kpm/min and 11 +/- 12% at 300 kpm/min) followed by a progressive and significant decline at peak exercise (-3.3 +/- 18% at 547 +/- 140 kpm/min; P < 0.05). There was substantial variation in end-diastolic volume response at peak exercise in the group as a whole, which could be more closely related to changes in end-systolic volume (r = 0.84, P < 0.0001) than in heart rate (r = -0.57, P < 0.01) or age (r = 0.36, P < 0.05) of the study subjects. Despite the decline in ventricular filling, systolic function appeared to improve dramatically at peak exercise (change in left ventricular ejection fraction 15.5 +/- 6.4, P < 0.0001). Although not directly related to increasing systolic ejection, end-diastolic volume was directly related to the percent change in stroke volume at peak exercise among the study subjects (r = 0.88, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Left ventricular mass, geometry, and filling in endurance athletes: association with exercise blood pressure

Karjalainen, Jouko, Matti Mäntysaari, MattiViitasalo, and Urho Kujala. Left ventricular mass, geometry,and filling in endurance athletes: association with exercise bloodpressure. J. Appl. Physiol. 82(2):531-537, 1997.We studied whether left ventricular (LV) mass andconcentricity [relative myocardial volume (RMV)] areassociated with exercise blood pressure (BP) in athletes. LV structureand filling were evaluated by Doppler echocardiography and BP inmaximal bicycle ergometry and isometric handgrip tests on 32 maleendurance athletes and 15 age-matched controls. Indexed LV mass was 145 ± 14 (SD) g/m in athletes and 93 ± 20 g/m incontrols. Mass was not associated with BP at rest or inlow-grade exercise, but with heavier exercise loads this associationstrengthened in athletes, being maximal at peak exercise(r = 0.65 for mass and 0.58 forindexed mass; P < 0.001). Multivariate analysis indicated that BP at peakexercise accounted for 34% and the amount of training for anadditional 11% of the variance in indexed LV mass. RMV was 21% largerin athletes. Only the increase in systolic BP during handgrip explainedsignificantly (19%) the variance in RMV. LV filling velocities werenot associated with mass, RMV, or BP. We conclude that in enduranceathletes LV mass is associated with BP in heavy dynamic exercise and LVconcentricity with BP response in static exercise.

     

Whole-genome association study for the roan coat color in an intercrossed pig population between Landrace and Korean native pig

The roan coat color is characterized by white hairs intermingled with colored hairs. Candidate genes based on comparative phenotypes in horses and cattle involve the KIT and KIT ligand (MGF) genes. Here, we report the result of the whole genome scanning to detect genomic regions responsible for the roan coat color, using a three-generation pedigree of 62 pigs in an intercross between Landrace and Korean native pig. These pigs were genotyped using the PorcineSNP 60 BeadChip (Illumina, USA). The whole genome scan indicated that three genomic regions, 35～36 Mb, 38～39 Mb, and 58～59 Mb on SSC8, were commonly and highly associated/linked with the roan phenotype in the case/control, sib-pair, and linkage test, respectively. The porcine KIT was selected as a candidate gene, because it is located in one of the three significant regions and its function is related to coat color formation. SNPs and Indels within coding sequence (CDS), promoter, and 3′-UTR of KIT were surveyed. Twenty-two SNPs in the CDS reported previously, as well as nine variations in promoter (2 SNPs) and 3′-UTR (5 SNPs and 2 Indels) were detected. Although no causative mutations were identified, these results will help to elucidate the genetic mechanisms involved in the expression of the roan phenotype and will aid in identifying key mutations responsible for the roan phenotype in further studies.     

Hypovitaminosis D in a normal, apparently healthy urban European population

Serum 25 OH Vitamin D (25 OH D) concentrations generally vary with latitude, season, and the composition of the population studied. There is a growing recognition that rather than a seasonal specific decline in serum 25 OH Vitamin D, a significant proportion of the population may exhibit asymtomatic subclinical Vitamin D insufficiency. Vitamin D insufficiency has been described in populations at risk, such as nursing home residents and the homebound elderly. We assessed a population of normal, apparently healthy volunteers at a single European urban center for 25 OH Vitamin D sufficiency. Serum 25 OH D concentrations were determined using an automated LIAISON((R)) 25 OH Vitamin D assay. For the purposes of this study, Vitamin D insufficiency was defined as a serum 25 OH Vitamin D concentration of <15 ng/mL. Of the total population (n = 126) 34% exhibited 25 OH Vitamin D concentrations of <15 ng/ml. The mean +/- S.D. serum 25 OH Vitamin D concentration among the total, sufficient, and insufficient populations was 19.4 +/- 7.7, 23.6 +/- 6.4, and 12.1 +/- 2.3 ng/mL. From these data, we conclude that 25 OH Vitamin D insufficiency is more common than previously thought, and is not restricted to high-risk groups.     

Replication of an African-American GWAS on blood pressure and hypertension in the Korean population

Hypertension is a complex disease that is caused by the interaction of multiple genetic and environmental risk factors, affecting 30% adult in industrialized countries. The identification of genetic factors that impact one’s predisposition to hypertension and its progression is an ongoing challenge. A genome-wide association study of African-Americans, who have one of the highest rates of hypertension in the world, was reported. We replicated the GWAS results in 8842 unrelated Koreans. Fifteen of the 30 reported SNPs were analyzed for their association with blood pressure and hypertension. Linear regression was used to analyze blood pressure as a quantitative trait in 7551 subjects, and a case-control study was performed using 1968 hypertensive cases and 4452 normotensive controls by logistic regression analysis. The quantitative trait study demonstrated a moderate association of 2 SNPs, rs9301196 (p=4.9×10^?3 for diastolic blood pressure) and rs2823756 (p=0.04 for systolic blood pressure), which were also associated with hypertension (p=0.042 and p=6.3×10^?3, respectively). Further, 3 SNPs were associated with hypertension (p=0.042 for rs7902529, p=0.027 for rs10135446, and p=0.01 for rs4613079) but not with blood pressure. Based on the moderate association signals and the low proportion of positive signals, this cross validation between African-Americans and Asians suggests that association studies of blood pressure traits require a larger number of subjects and a more refined design.     

Relations of serum interleukin 18 levels to serum lipid and glucose concentrations in an apparently healthy adult population

AIM: To investigate the associations between serum interleukin (IL) 18 concentrations and indices of lipid and carbohydrate metabolism in healthy adults. METHODS: Fasting serum concentrations of IL-18, glucose, total cholesterol, triglyceride, and high- and low-density lipoprotein cholesterols were measured in 570 apparently healthy adults. RESULTS: Univariate linear and partial regression analyses showed that the serum IL-18 concentration was positively correlated with serum triglyceride and glucose concentrations in both obese and diabetic subjects after controlling for the confounding effects of age, sex, and body mass index. CONCLUSION: IL-18 may be associated with obesity and glucose intolerance.